The effect of arteriovenous malformation resection on cerebrovascular reactivity to carbon dioxide.
The effect of arteriovenous malformation resection on cerebrovascular reactivity to carbon dioxide.
复制标题
动静脉畸形切除对脑血管对二氧化碳反应性的影响。
DOI：
10.1097/00006123-199008000-00015
复制
发表时间：
1990
期刊：
影响因子：
4.8
通讯作者：
Bennett M. Stein
中科院分区：
文献类型：
--
作者：
W. Young;I. Prohovnik;E. Ornstein;N. Ostapkovich;M. Sisti;R. Solomon;Bennett M. Stein
为了探讨动静脉畸形（AVMs）闭塞术与脑血流动力学的关系，我们研究了26例在异氟醚和N2/O2麻醉下行动静脉畸形全显微手术切除的患者。检测器放置在离病灶边缘5 - 6cm的对侧位置。在每个阶段低碳酸血症和正常碳酸血症期间，采用静脉注射氙-133技术测量AVM切除术前后的脑血流量（CBF）。术中CBF的变化与基于患者病史和术前血管造影的风险评分系统有关。7名接受脊柱手术的健康患者进行了研究，以控制麻醉效果。AVM组的患者人口统计和临床数据符合AVM人群的预期水平。CBF从切除前的22 +/- 1 ml/100 g/min增加到切除后的30 +/- 2 ml/100 g/min，平均+/- SE， n = 25, P < 0.002)，无半球差异。CO2反应性在切除后略有增加（切除前为4.2 +/- 0.3%变化/mm Hg，切除后为4.7 +/- 0.3%变化/mm Hg， n = 14, P < 0.02）。基线CBF和CO2反应性与对照组无显著差异。风险评分与同侧CBF变化百分比之间存在弱相关性，且风险最低的患者术后CBF变化有最低的趋势。CO2反应性与危险等级无相关性。没有病人从麻醉中醒来时出现意外的神经功能缺陷。CBF最高的增加与一名患者的术后脑肿胀和另一名患者的致死性脑出血有关。两例患者在切除前CO2反应性正常。1例患者术后脑出血，可归因于技术问题，CBF未增加。我们的结论是，由于分流闭塞导致动静脉压梯度（和脑灌注压）的急性增加，AVM切除可以立即增加CBF。在切除前后，脑血管对二氧化碳的反应性保持不变。
To investigate the cerebral hemodynamic changes associated with obliteration of arteriovenous malformations (AVMs), we studied 26 patients undergoing total microsurgical AVM resection during isoflurane and N2/O2 anesthesia. Detectors were placed 5 to 6 cm from the margin of the lesion and in a homologous contralateral position. Cerebral blood flow (CBF) was measured using the intravenous xenon-133 technique before and after AVM resection, during both hypocapnia and normocapnia at each stage. Intraoperative changes in CBF were related to a risk score system based on the patient's history and preoperative angiograms. Seven otherwise healthy patients undergoing spinal surgery were studied to control for anesthetic effects. Patient demographic and clinical data for the AVM group conformed to the expected strata of a large AVM population. The CBF increased after excision (22 +/- 1 ml/100 g/min before excision to 30 +/- 2 ml/100 g/min after excision; mean +/- SE, n = 25, P less than 0.002) without a hemispheric difference. CO2 reactivity increased slightly after excision (4.2 +/- 0.3% change/mm Hg before excision to 4.7 +/- 0.3% change/mm Hg after excision; n = 14, P less than 0.02). The baseline CBF and CO2 reactivity were not different from the control group. There was a weak correlation between the risk score and the percentage of change in the ipsilateral CBF, with a trend for the patients with the lowest risk to have the lowest CBF changes after resection. There was no relationship between CO2 reactivity and risk grade. None of the patients awoke from anesthesia with unexpected neurological deficits. The highest CBF increases were associated with postoperative brain swelling in one patient and fatal intracerebral hemorrhage in another. Both patients had normal CO2 reactivity before excision. One patient suffered postoperative intracerebral hemorrhage, attributable to technical problems, and had no increase in CBF. We conclude that, with an acute increase in the arteriovenous pressure gradient (and cerebral perfusion pressure) that results from shunt obliteration, there is an immediate global effect of AVM resection to increase CBF. Cerebrovascular reactivity to CO2 remains intact both before and after excision.